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Financial Supports

Caring for a child with special health care needs can often be financially overwhelming. If you lack adequate health insurance coverage, or have no insurance at all, there are many organizations you can contact for help with your child's health care costs.

Social Security

Let's start by looking at Social Security (SSI). Millions of children currently receive benefits from Social Security and your child may qualify, too. Listed below are three ways your child might be eligible for Social Security or SSI:

SSI Benefits For Children

These are benefits payable to disabled children under age 18 who have limited income and resources, or who come from homes with limited income and resources.

Social Security Dependents Benefits

These are benefits payable to children under the age of 18 on the record of a parent who is collecting retirement or disability benefits from Social Security, or survivors benefits payable to children under the age of 18 on the record of a parent who has died.

Although children under age 18 who are eligible for these benefits might be disabled, we do not need to consider their disability to qualify them for benefits.

Note: A child can continue receiving dependents or survivors benefits until age 19 if he or she is a full-time student in elementary or high school.

Social Security Benefits For Adults Disabled Since Childhood

Dependent's benefits normally stop when a child reaches age 18 (or 19 if the child is a full-time student). However, those benefits can continue to be paid into adulthood if the child is disabled. To qualify for these benefits, an individual must be eligible as the child of someone who is getting Social Security retirement or disability benefits, or of someone who has died, and that child must have a disability that began prior to age 22.

Although most of the people getting these benefits are in their 20s and 30s (and some even older), the benefit is considered a "child's" benefit because it is paid on the basis of a parent's Social Security earnings record.

For details on qualifying for Social Security or SSI visit www.socialsecurity.gov and read the complete Social Security Online Electronic Booklet.

Medicaid and Medicare

Medicaid is a health care program for people with low incomes and limited assets. In most states, children who get SSI benefits qualify for Medicaid. In many states, Medicaid comes automatically with SSI eligibility. In other states, you must sign up for it. And some children can get Medicaid coverage even if they don't qualify for SSI. Check with your local Social Security office or your state or county social services office for more information.

Medicare is a federal health insurance program for people 65 or older, and for people who have been getting Social Security disability benefits for two years. Because children, even those with disabilities, do not get Social Security disability benefits until they turn 18, no child can get Medicare coverage until he or she is 20 years old.

The only exception to this rule is for children with chronic renal disease who need a kidney transplant or maintenance dialysis. Children with chronic renal disease can get Medicare if a parent is getting Social Security or has worked enough to be covered by Social Security.

State Children's Health Insurance Program (SCHIP or CHIP)

Legislation passed in 1997 created a new Title XXI of the Social Security Act, known as the State Children's Health Insurance Program (SCHIP). This new program enables states to insure children from working families with incomes too high to qualify for Medicaid, but too low to afford private health insurance. The program provides protection for prescription drugs, vision, hearing and mental health services and is available in all 50 states, and the District o Columbia, Your state Medicaid agency can provide more information about CHIP. Or, you can go directly to http://www.cms.hhs.gov/home/schip.asp.

Other Health Care Services

If the Social Security office decides a child is disabled and eligible for SSI, they refer him or her for health care services under the Children with Special Health Care Needs (CSHCN) provisions of the Social Security Act . These programs are generally administered through state health agencies.

Although there are differences, most CSHCN programs help provide specialized services through arrangements with clinics, private offices, hospital-based out- and in-patient treatment centers or community agencies.

CSHCN programs are known in the states by a variety of names, including Children's Special Health Services, Children's Medical Services and Handicapped Children's Program. Even if your child is not eligible for SSI, a CSHCN program may be able to help you. Local health departments, social services offices or hospitals should be able to help you contact your CSHCN program.

For additional information see Health Insurance/Financial Aids, and Newsletters & Conference Calls.

Resources

Information & Support

For Professionals

State Children's Health Insurance Program (SCHIP)
Official U.S. government site for SCHIP services; information includes eligibility, enrollment and general information about health insurance for kids.

For Parents and Patients

Benefits for Children with Disabilities
This electronic booklet illustrates the kinds of Social Security and Supplemental Security Income (SSI) benefits a child with a disability might be eligible for; call toll-free 1-800-772-1213.

EPSDT Fact Sheet (PDF Document 48 KB)
Information, tips, and resources from the Utah Family Voices Health Information & Support center.

Medicaid D Fact Sheet (PDF Document 48 KB)
Information, tips, and resources from the Utah Family Voices Health Information & Support center.

Authors

Authors: Robin Pratt, 12/2003
Gina Pola-Money, 12/2003
Reviewing Author: Alfred Romeo RN, PhD, 7/2008
Content Last Updated: 7/2008